October 2011 | A Better You | Osteoporosis and You

Give your bones a break—so they don’t give you one

By Suzanne Martin, PT, DPT

Why should dance teachers worry about their bones? Osteoporosis is basically an epidemic. About 10 million Americans have this bone-weakening disease, with another 34 million at risk, the National Osteoporosis Foundation says.  The American College of Sports Medicine has warned that women in all athletics—and dance is nothing if not athletic—are at risk for osteoporosis, amennorhea, and eating disorders. It also pointed out that eating disorders and malnutrition are both detrimental to the formation of bone.

Two years ago I attended a continuing-education program given by the Foundation for Osteoporosis Research and Education, where endocrinologists explained that osteoporosis isn’t diagnosed until the patient suffers a fracture. In women, the first fractures begin in their 50s at the wrist, followed in their 60s by fractures in the thoracic spine vertebrae, with hip fractures usually occurring in their 70s. (Because estrogen is critical to bone formation in women, they tend to lose more bone after menopause.)

Think of a dancer’s typical life trajectory. Dance students, especially in ballet, face the challenge of staying lean while mustering the strength and stamina to fulfill their performance goals. When I conducted an informal survey of 15- to 17-year-olds in my nutrition lectures at San Francisco Ballet School, a surprising number of dancers said they wished they could keep the weight and body shape that they’d had at age 14. This may reflect the popular misconception that thinner is always better, but remember that when you lose weight, you don’t just lose fat—you also lose bone and muscle.

Also, it’s no secret that young dancers in the midst of early bone formation are more susceptible to lower-extremity and spinal stress fractures when their periods are delayed or absent because of their rigorous exercise and low body fat. Low body weight means low lean muscle and low skeletal weight as well as low body fat. Growth generally is accomplished by about age 20. The stresses and strains endured by young dancers during their pre- and early professional years set up the skeletal frame they will have for the rest of their lives.

The dancer who goes on to pursue a teaching career, then, may think she’s out of the woods: she can pay less attention to diet because she doesn’t face the energy demands of performance, or an audience’s expectation of ballerina-slim dancers. But think twice. Bone growth (geometry and density) peaks by about age 35. The goal then becomes keeping the baseline bone amount steady until old age.

How can you ensure that a formerly stressed skeleton can stay strong for a lifetime? Here are some dos and don’ts that you can tape to your bathroom mirror.

First, eat wisely. We all know about the necessity of daily calcium, and I’ve written about the importance of Vitamin D supplements (the new recommended daily allowance, or RDA, is 1,000mg/day). Sitting out in the sun for 20 minutes a day with arms, legs, and chest exposed may give you good Vitamin D, but watch out—wearing sunscreen, inconsistency, and distance from the equator all interfere with exposure to UVB radiation, which means you might not really get your daily Vitamin D dose that way.

Make sure your diet has enough protein—it’s essential for aging bones. The RDA for adult women is about 0.4 grams per pound of body weight, and protein sources are easy to research online. We may not need as much as when we were performing, but I know I have to push to get enough since I eat lightly. My typical breakfast of hot cocoa, oatmeal, and flax seed meal gives me about 25 grams. The protein helps to stabilize my blood sugar and the starchy carbohydrate gives me satisfaction until lunchtime.

Protein is also necessary to counteract sarcopenia, the muscle loss experienced as we progress from middle age to old age. Bones and tendons depend on the pull of muscle to increase bone density. Almonds, oysters, and leafy green vegetables such as collard greens add variety and natural calcium to the diet, as do the tried-and-true dairy products of milk and yogurt.

Next, stay strong with resistance exercise. I use light weights—from 3 to 10 pounds, depending on the exercise. You won’t bulk up, and some upper-body weight work will keep your neck happy.

  1. Stand in parallel with your feet just less than hip-width apart. Hold a 5-pound weight in each hand and make shoulder rolls (backward only; we already round forward too much) about 10 times.
  2. Place the weights at either side of your thighs. Slide the weights up and down the sides of your thighs for about a 6-inch excursion. Open the elbows sideways as if a puff of air were opening the armpits as you slide upward. Do about 10 repetitions.
  3. Hold a 1- to 5-pound weight at each end with your arms fully extended toward the floor. Lift the weight to chin height while winging the elbows up and out. Feel as though your core is lifting the weight as it slides up past the front of your body to the chin. Do 1 to 3 sets of 10 repetitions.
  4. Keep holding the weight in both hands and place it overhead, toward the back of your head. Elbows point upwards. Lift the weight up toward the ceiling, straightening the elbows, and then lower the weight again. Do 1 to 3 sets of 10 repetitions.
  5. Bent-over rows are helpful to keep the thoracic spine strong.
    a. At the barre, take a 5-pound weight in each hand and stand in a flat-back position. Be sure to hold your abdominals. Lean your forehead on the barre (a folded towel will lessen the pressure).
    b. Lower the weights toward the floor, then exhale and lift them to the sides of your chest. Lower slowly in 4 counts. Do about 10 repetitions
  6. Planks front, side, and back are the best way to protect the three danger spots of wrists, mid-back, and hips.
    a. On your hands and knees, in a flat-back position, engage the abs, back, and pelvic floor. Reach the feet back and lengthen out into one long line. Hold for 20 counts. Repeat once.
    b. Lie on your side with your forearm on the mat and your legs in parallel with the feet dorsiflexed so that the toes are pulling back toward the  shins. Exhale and elevate the hips. Hold for 4 breaths and lower. Do 4 repetitions.
    c. In a seated position, put your hands on the floor behind you with the fingers pointing toward the pelvis. Lengthen the legs in front of you.
    Again, dorsiflex the ankles. Exhale and elevate the pelvis. Keep the elbows bent. Breathe 4 times and lower. Repeat once more.

Research with osteoporosis patients as far back as 1984 has shown that extension exercises offer the most protection against fractures. The Pilates swim is an example. Lie on your abdomen. Imagine there’s an ice cube under your waist so that you lift the abdominals. Exhale and lift the head (keep looking down), and then lift the arms and thighs an inch off the floor. Gently paddle the arms and kick the legs for 20 to 30 counts.

Keep jumping. Bone growth is stimulated by stress, and impact offers the greatest benefit. Keep your relevé strong so that you can still jump a bit in class. Some judicious jumping will keep those hips strong. Remember the Magic 25? (See “A Better You: Better Balance,” May 2011.) Just stand at the barre in parallel and make 25 brisk elevés. Hold the last one and fully engage every muscle fiber you can muster.

Get outside. Walking and hiking are great for dancers. Jogging and full-out sprinting may be hard on longtime dance legs, so it might be best to save the big jumps for sprung floors.

Protecting our bones means job insurance. Eat smart, move smart, be smart.

I have faith in you.